Total knee arthroplasty (TKA) is a surgical alternative for patients with osteoarthritis (OA) of the knee unresponsive to medical therapy. This procedure is considered to be very effective, with successful reduction of pain and improvement of function in most patients. However, about 25% of individuals report little improvement, unrelated to technical complications. Patients with high levels of distress tend to have a worse outcome. We hypothesize that patient psychosocial characteristics and their expectations about surgery may have an impact on their post-operative attitudes and behaviors in relation to recovery, rehabilitation and return to their usual daily activities. The aims of the proposal are: a) To identify beliefs, expectations and goals of patients undergoing TKA; b) To determine which are appropriate and realistic goals for patients undergoing knee arthroplasty; c) To develop an instrument to evaluate patient beliefs, expectations and goals in relation to TKA; d) To identify psychosocial and educational barriers to surgical success and patient satisfaction after TKA; e) To evaluate the impact of psychological determinants, and TKA outcomes on health costs; and f) To develop and pilot test a patient-centered, cognitive behavioral and psycho-educational intervention for patients undergoing TKA, with the goal of maximizing functional outcomes and patient satisfaction. In Phase 1 we will conduct patient focus groups to collect qualitative information on patient expectations and goals about TKA. We will also assemble an expert panel to establish which are rational goals for these patients to attain after their surgery. In Phase 2 we will use the information gathered from Phase 1 to conduct a short term cohort study of patients undergoing TKA. We will develop and test in this cohort an instrument to ascertain patient expectations and goals, and we will conduct a 6-month outcome study to identify psychosocial and psycho-educational determinants of outcome in this population. Extensive work has been conducted in surgical populations in relation to these factors, but the literature on joint replacement is scarce. The information from previous perioperative intervention studies, and the findings from Phases 1 and 2 will be the basis of a psycho-educational intervention that will be pilot tested in 20 patients in Phase 3. The intervention will be based on cognitive behavioral strategies.